Touch screen finger position indicator for a spinal cord stimulation programming device

ABSTRACT

A method of visualizing a user interaction with a clinician programmer is disclosed. A user engagement with respect to a screen of the clinician programmer is detected via one or more sensors associated with the screen of the clinician programmer. One or more locations on the screen of the clinician programmer corresponding to the user engagement is determined. An external monitor is communicatively coupled to the clinician programmer. The external monitor displays one or more cursors that graphically represent the one or more locations on the screen of the clinician programmer corresponding to the user engagement, respectively.

PRIORITY DATA

The present application is a utility application of provisional U.S.Patent Application No. 61/695,394, filed on Aug. 31, 2012, entitled“Touch Screen Finger Position Indicator for a Spinal Cord StimulationProgramming Device,” and a continuation-in-part (CIP) application ofUtility U.S. patent application Ser. No. 13/600,875, filed on Aug. 31,2012, entitled “Clinician Programming System and Method”, thedisclosures of each which are hereby incorporated by reference in theirentirety.

FIELD OF THE INVENTION

This disclosure is directed to an external monitor connection for aclinician programmer and the display of one or more simulated cursors.

BACKGROUND

Neurostimulation devices deliver therapy in the form of electricalstimulation pulses to treat symptoms and conditions, such as chronicpain, Parkinson's disease, or epilepsy, for example. Implantableneurostimulation devices, for example, deliver neurostimulation therapyvia leads that include electrodes located proximate to the muscles andnerves of a patient.

Clinician programmers are used to control and program theneurostimulation devices with stimulation sequences to treat symptomsand conditions. These clinician programmers and devices of their typeare relatively small to allow for easy transportation and storage. Theportability has its price, however. It is difficult for more than oneperson to view the relatively small screen of a handheld programmer.People would have to crowd around the device to be able to attempt tosee what is happening on the screen.

Further, even though the clinician programmer is portable, there aresome areas where its use may be restricted. For instance, a clinicianprogrammer may be covered under the drapes while a sales representativeis talking to the patient. The clinician programmer thus may not bevisible to the physician. As another example, the clinician programmermay not be a sterile device and cannot be taken into the sterile fieldin an operating room. Since the clinician programmer must remain outsideof the sterile field, the physician is unable to read the screen whileperforming the procedure. Accordingly, the physician must verballyinteract with and rely on someone (an external operator), who acts ashis eyes and hands controlling the programmer outside of the sterilefield. The situation could also be reversed, where the physician isdoing the programming, and the staff is observing his/her actions, forexample, talking to the patient at the head end of the surgery table. Inany case, requiring an extra person results in additional time for theprocedure to be completed as a result of the verbal communication of theprogramming device state and adjustments to be made between thephysician and the external operator. The verbal interchange may alsoresult in miscommunication which will add additional time to completethe procedure and possibly result in more severe consequences.

In addition, due to the small size of the clinician programmer, it maybe difficult for users and observers to precisely identify an area ofthe screen (on the clinician programmer) where the user is performingdata entry or other programming actions. In other words, users andobservers may not know what part of the screen is being touched whilethe user is interacting with the user interface. Also, if device iscoupled to an external monitor, observers will not know what part of theclinician screen is being touched by the user, especially if theexternal monitor and the observers are typically located in a separateroom than the clinician programmer and the user.

The present disclosure is directed to devices, systems, and methods thataddress one or more deficiencies in the prior art.

SUMMARY

This disclosure is directed to a patient programmer in communicationwith an external monitor that helps to alleviate the problems set outabove. When demonstrating the device, for example, the screen can bedisplayed on a large monitor for group viewing. In addition, when usedfor a procedure within an operating room, the programmer can be keptoutside the sterile field, but its user interface can be made availablefor viewing by the physician and others through a projector or largescreen monitor. In many cases, the external screen may be the onlyscreen that the physician can see, because the clinician programmer isunder the cover or tucked away.

In one exemplary aspect, the present disclosure is directed to aclinician programming system operable to control an implantable medicaldevice. The clinician programming system includes a clinician programmerwith a housing. The clinician programmer includes: a processor andmemory having executable instructions enabling programming of animplantable pulse generator; a user interface configured to receiveinputs by a clinician instructing operation of an implantable pulsegenerator; a first display configured to display information indicativeof the inputs by the clinician or display information indicative ofstatus of an implantable pulse generator, the first display having afirst display size; an implant communication interface configured totransmit information from the clinician programmer to an implantablepulse generator and configured to receive information from animplantable pulse generator; and a display communication interfaceconfigured to transmit content shown on the display. The clinicianprogramming system also includes a secondary unit separate from thehousing of the clinician programmer, the secondary unit having asecondary display of a second display size, the secondary display beingconfigured to communicate with the clinician programmer via thesecondary display communication interface and configured to displayinformation received via the secondary display communication interface.The secondary display may display information either mirrored orextended from the clinician programmer.

In one exemplary aspect, the present disclosure is directed to aclinician programmer. The clinician programmer includes a first displayconfigured to display information to a user relating to an implantabledevice; a user input mechanism configured to receive inputs from theuser controlling content shown on the first display; a secondary unitcommunication interface selectively attachable to a secondary unit, thesecondary unit communication interface configured to transmitinformation to a secondary unit having a secondary display andconfigured to receive information for processing from the secondaryunit; and a controller configured to receive a user input from the userinput mechanism, the user input selecting a first mode that sends adisplay signal to the secondary display causing content shown on thesecondary display to mirror or extend content shown on the first displayand a second mode that sends a display signal to the secondary displaycausing content shown on the secondary display to differ from contentshown on the primary display.

In one exemplary aspect, the present disclosure is directed to aclinician programmer. The clinician programmer includes a programmingsoftware module configured to generate a treatment program executable onan implantable medical device as a result of a user input; an implantcommunication interface configured to send the treatment program to animplantable medical device to operate the implantable device andconfigured to receive information from the implantable device; a primarydisplay configured to display information relating to the treatmentprogram; a secondary display unit communication interface configured totransmit information to a secondary display unit and configured toreceive information from a secondary display unit; a microphone incommunication with the secondary display unit communication interfaceand configured to capture audio from the user for transmission from thesecondary display unit communication interface; and a speaker incommunication with the a secondary display unit communication interfaceand configured to receive signals representing audio captured at thesecondary display unit.

In one exemplary aspect, the present disclosure is directed to asurgical arrangement used when programming an implantable medicaldevice. The surgical arrangement includes: a non-sterile (or wrappedsterile) clinician programmer having a memory storing instructionalinformation for programming an implantable pulse generator and having afirst display screen configured to display the instructional informationto a user, the clinician programmer having a secondary display unitinterface comprising a transmitter and a receiver configured to senddisplay signals and configured to receive instructional signals; asecondary unit comprising a second display screen sized larger than theclinician programmer first display screen, the second display screenbeing disposed for viewing from a sterile room and connectable with theclinician programmer, the secondary unit being configured to receive theinstructional information from the clinician programmer and display theinstructional information on the second display screen under theinstruction of the clinician programmer; and an implantable pulsegenerator in communication with one of the secondary unit and theclinician programmer, the implantable pulse generator having a memoryand processor configured to activate electrodes based on informationreceived from said one of the secondary unit and the clinicianprogrammer, the implantable pulse generator being configured toelectrically receive said information displayed relating to an electrodeof the implantable pulse generator.

In one exemplary aspect, the present disclosure is directed to a methodfor performing trial stimulation during neurostimulator implant surgery.The method includes: providing a clinician programmer having a firstdisplay screen having a first display screen size; providing an externalsecondary unit having a second display screen having a second displayscreen size that is visible to medical personnel, for example operatingroom staff working within the sterile field; providing at least onestimulation lead operable to provide electrical stimulation to targettissue within a patient; connecting the clinician programmer to theexternal monitor; operating the clinician programmer to control thestimulation provided through the stimulation lead and to displayinformation related to the stimulation on the external monitor; anddisplaying information relating to the stimulation lead on either one ofthe first and the second display screens, or both.

In one exemplary aspect, the present disclosure is directed to a methodfor programming an implantable device. The method includes: receiving aninput at a user interface on a tablet-style clinician programmer;generating a first display signal on the clinician programmer thatupdates content on a first display based on the received user input, thefirst display having a first size; generating a second display signalfor transmission to a secondary unit having a second display separatefrom the clinician programmer, the second display having a second size,wherein generating the second display signal includes enhancing thecontent of the second display signal to provide a clear image on thesecond size display; and transmitting the second display signal from theclinician programmer to the second display.

Yet another aspect of the present disclosure involves a clinicianprogrammer. The clinician programmer includes: a touch-sensitive screenconfigured to display visual content to a user; one or more sensorsconfigured to detect an engagement from the user with respect to thescreen; a transceiver configured to conduct telecommunications with anexternal monitor that is multiple times larger than the clinicianprogrammer; a memory storage component configured to store programminginstructions; and a computer processor configured to execute theprogramming instructions to perform the following tasks: detecting, viathe one or more sensors, the engagement from the user with respect tothe screen; determining one or more locations on the screencorresponding to the user engagement; and sending signals, via thetransceiver, to the external monitor to display one or more cursors onthe external monitor, the one or more cursors graphically representingthe one or more locations on the screen of the clinician programmercorresponding to the user engagement, respectively.

Another aspect of the present disclosure involves a medical system. Themedical system includes: a monitor; and a clinician programmer locatedremotely from the monitor, the clinician programmer being configured toprogram parameters of an electrical stimulation therapy for a patient,the clinician programmer including: a touch-sensitive screen configuredto display visual content to a user; one or more sensors configured todetect an engagement from the user with respect to the screen; atransceiver configured to conduct telecommunications with the monitor; amemory storage component configured to store programming instructions;and a computer processor configured to execute the programminginstructions to perform the following tasks: detecting, via the one ormore sensors, the engagement from the user with respect to the screen;determining one or more locations on the screen corresponding to theuser engagement; and sending signals, via the transceiver, to themonitor to display one or more cursors on the monitor, the one or morecursors graphically representing the one or more locations on the screenof the clinician programmer corresponding to the user engagement,respectively.

Yet another aspect of the present disclosure involves a method ofvisualizing a user interaction with a clinician programmer. The methodincludes: detecting a user engagement with respect to a screen of theclinician programmer via one or more sensors associated with the screenof the clinician programmer; determining one or more locations on thescreen of the clinician programmer corresponding to the user engagement;and displaying, via an external monitor communicatively coupled to theclinician programmer, one or more cursors that graphically represent theone or more locations on the screen of the clinician programmercorresponding to the user engagement, respectively.

Yet one more aspect of the present disclosure involves an apparatus forvisualizing a user interaction. The apparatus includes: means fordetecting a user engagement with respect to a screen of a clinicianprogrammer, the clinician programmer being configured to program a pulsegenerator so that the pulse generator delivers an electrical stimulationtherapy to a patient; means for determining one or more locations on thescreen of the clinician programmer corresponding to the user engagement;and means for displaying or more cursors that graphically represent theone or more locations on the screen of the clinician programmercorresponding to the user engagement, respectively, wherein the meansfor the displaying is remotely located from, and communicatively coupledto, the clinician programmer.

BRIEF DESCRIPTION OF THE DRAWINGS

Aspects of the present disclosure are best understood from the followingdetailed description when read with the accompanying figures.

FIGS. 1A and 1B are illustrations of a patient's spine with an exemplaryelectrical stimulator treatment system disposed to treat a particularregion of the spine in accordance with one aspect of the presentdisclosure.

FIG. 2 is a block diagram showing an exemplary external monitorinterface system in accordance with one aspect of the presentdisclosure.

FIG. 3 is a block diagram of a clinician programmer for use in theexemplary external monitor interface system of FIG. 2.

FIG. 4 is an exemplary user interface illustrating the generation of apain map or a stimulation map.

FIG. 5 is an illustration of an exemplary use of the exemplary externalmonitor interface system of FIG. 2 in accordance with one exemplaryaspect of the present disclosure.

FIG. 6 is an illustration of an exemplary use of the exemplary externalmonitor interface system of FIG. 2 in accordance with one exemplaryaspect of the present disclosure.

FIG. 7 is a flow chart showing an exemplary method of using the externalmonitor interface system of FIG. 2 in accordance with one exemplaryaspect of the present disclosure.

FIGS. 8A-8B are example user interfaces illustrating one or moresimulated cursors in accordance with one exemplary aspect of the presentdisclosure.

FIG. 9 is a simplified block diagram of an example medical systemaccording to various aspects of the present disclosure.

FIG. 10 is a simplified block diagram of an implantable medical deviceaccording to various aspects of the present disclosure.

FIG. 11 is a simplified block diagram of a medical system/infrastructureaccording to various aspects of the present disclosure.

FIGS. 12-13 are simplified flowcharts illustrating a method ofvisualizing a user interaction with a clinician programmer according tovarious aspects of the present disclosure.

DETAILED DESCRIPTION

The following disclosure provides many different embodiments, orexamples, for implementing different features of various embodiments.Specific examples of components and arrangements are described below tosimplify the present disclosure. These are, of course, merely examplesand are not intended to be limiting. In addition, the present disclosuremay repeat reference numerals and/or letters in the various examples.This repetition is for the purpose of simplicity and clarity and doesnot in itself dictate a relationship between the various embodimentsand/or configurations discussed.

The devices, systems, and methods described herein introduce an improvedway for controlling and programming an implanted medical device. Theyuse a clinician programmer (“CP”) with a first display electricallycoupled (for example, coupled in a wired or wireless manner) to a seconddisplay disposed for viewing by others than the clinician performing theprogramming. In one example, the CP may be outside a sterile field, butmay be in communication with a display viewable to others who are withinthe sterile field. This may be particularly helpful to surgeons whoperform surgeries and must issue instructions to a programming clinicianto direct or control an implant in a certain manner. The surgeon maylook at the second display and see the settings and programming as itoccurs on the CP, instead of relying merely on verbal feedback from theprogramming clinician. This may streamline the surgery and since thesurgeon can now see the clinician programming screen, may help assurethe surgeon that his instructions are being carried out as requestedwithout relying solely on verbal feedback. This may reduce verbalcommunication errors between staff during programming. Accordingly, thismay provide a level of redundancy and risk management not achieved whenprogramming is performed with only a CP outside the sterile field. Inanother example, the CP sends information shown on its display to thesecond larger display for viewing by additional people. This may beparticularly helpful during training processes, when the clinician maybe instructing trainees or other clinicians in treatment techniques, forexample.

FIG. 1A is a side view of a spine 10, and FIG. 1B is a posterior view ofthe spine 10. FIG. 1B shows an exemplary electrical stimulator treatmentsystem 100 disposed to treat a spinal region for treating a symptom,such as chronic pain. The system includes an implantable pulse generator(IPG) 102 that delivers electrical stimulation therapy to the patient,and a CP 104.

Referring now to FIGS. 1A and 1B, the spine 10 includes a cervicalregion 11, a thoracic region 12, a lumbar region 14, and asacrococcygeal region 16. The cervical region 11 includes the top sevenvertebrae, which may be designated with C1-C7. The thoracic region 12includes the next twelve vertebrae below the cervical region 11, whichmay be designated with T1-T12. The lumbar region 14 includes the finalfive “true” vertebrae, which may be designated with L1-L5. Thesacrococcygeal region 16 includes nine fused vertebrae that make up thesacrum and the coccyx. The fused vertebrae of the sacrum may bedesignated with S1-S5.

Neural tissue (not illustrated for the sake of simplicity) branches offfrom the spinal cord through spaces between the adjacent vertebrae. Theneural tissue, along with the cord itself, can be individually andselectively stimulated in accordance with various aspects of the presentdisclosure. For example, referring to FIG. 1B, the IPG 102 is implantedinside the body. A conductive lead 108 is electrically coupled to thecircuitry inside the IPG 102. The conductive lead 108 may be removablycoupled to the IPG 102 through a connector, for example. A distal end ofthe conductive lead 108 is attached to one or more electrodes 110. Inthe example shown, the electrodes 110 are implanted adjacent to adesired nerve tissue in the thoracic region 12. The distal end of thelead 108 with its accompanying electrodes may be positioned beneath thedura mater using well-established and known techniques in the art.

The electrodes 110 deliver current drawn from the IPG 102, therebygenerating an electric field near the neural tissue. The electric fieldstimulates the neural tissue to accomplish its intended functions. Forexample, the neural stimulation may alleviate pain in an embodiment. Inother embodiments, a stimulator as described above may be placed indifferent locations throughout the body and may be programmed to addressa variety of problems, including for example but without limitation;prevention or reduction of epileptic seizures, bladder control, weightcontrol or regulation of heart beats.

It is understood that the IPG 102, the lead 108, and the electrodes 110may be implanted completely inside the body, or may have only one ormore components implanted within the body while other components remainoutside the body. When they are implanted inside the body, the implantlocation may be adjusted (e.g., anywhere along the spine 10) to deliverthe intended therapeutic effects of spinal cord electrical stimulationin a desired region of the spine. The IPG 102 in this system is a fullyimplantable, battery-powered neurostimulation device for providingelectrical stimulation to a body region of a patient. In someembodiments, an external pulse generator (EPG) is used. The EPG isidentical to the IPG but the connection is done through percutaneouswires (communication may still be wireless though). In the example shownin FIG. 1B, the IPG 102 is configured to provide neural stimulation tothe spine. However, in other embodiments, IPG 102 may be a differenttype of pulse generator, including, for example, a pacemaker, adefibrillator, a trial stimulator or any other type of medical device.Here, the IPG 102 is structurally configured and arranged for wirelessprogramming and control through the skin of the patient. Accordingly, itincludes a transmitter and receiver capable of communicating withexternal programming and control devices, such as the CP 104. It alsoincludes a rechargeable power source, such as a battery configured to bewirelessly recharged through the patient's skin when a charger isexternally placed in the proximity of the IPG 102.

The CP 104 is typically maintained in a health care provider'spossession and can be used to program the IPG 102 as a part of theimplantation treatment and later during office visits. For example only,the CP 104 can define the available stimulation programs for the IPG 102by enabling and disabling particular stimulation programs, can definethe actual stimulation programs by creating defined relationshipsbetween pulses, and perform other functions.

FIG. 2 is a block diagram showing an exemplary clinician programmingsystem 150. The programming system 150 includes the CP 104, the IPG 102,a secondary display unit 152, a patient feedback tool (“PFT”) 210, and asurgeon input device 212.

The CP 104 is, in one embodiment, a tablet-style device with a touchscreen and radios for communicating with active implantable medicaldevices, such as neurostimulators like the IPG 102. As can be seen inFIG. 2, the CP 104 includes a processor 160, memory 162, a userinterface 164, and a communication interface 166.

As shown in FIG. 2, the user interface 164 includes a primary displayscreen 168, an input mechanism 170, a speaker 172, and a microphone 174.The speaker 172 and the microphone 174 enable audio communicationbetween the CP 104 and the secondary display unit 152. For example, thespeaker 172 may be linked with a microphone 186 on the secondary displayunit 152, and the microphone 174 may enable communication with a speaker184 on the secondary display unit 152. As described below, this may beuseful when the CP 104 and the secondary display unit 152 are indifferent locations.

The communication interface 166 enables the CP 104 to communicate withother components of the clinician programming system 150. In theembodiment shown, the communication interface 166 includes a secondarydisplay communication interface 176 and a peripheral interface 178.These, along with other elements of the CP 104, are described in detailwith reference to FIG. 3.

FIG. 3 shows a block diagram of a more detailed construction of the CP104. Referring to FIG. 3, the CP 104 includes a printed circuit board(“PCB”) that is populated with a plurality of electrical and electroniccomponents that provide power, operational control, and protection tothe CP 104. The processor 160 is a controller for controlling the CP104, and indirectly programming, controlling, and responding to the IPG102, the secondary display unit 152, the PFT 210, and the surgeon inputdevice 212. In one construction, the processor 160 is an applicationsprocessor model i.MX515 available from Freescale Semiconductor. Morespecifically, the i.MX515 applications processor has internalinstruction and data caches, multimedia capabilities, external memoryinterfacing, and interfacing flexibility. Further information regardingthe i.MX515 applications processor can be found in, for example, the“IMX510EC, Rev. 4” data sheet; dated August 2010; published by FreescaleSemiconductor at www.freescale.com, the content of the data sheet beingincorporated herein by reference. Of course, other processing units,such as other microprocessors, microcontrollers, digital signalprocessors, etc., can be used in place of the processor 160.

The CP 104 includes memory 162, which can be internal to the processor160 (e.g., memory 305), external to the processor 160 (e.g., memory310), or a combination of both. The memory 162 stores sets ofinstructional information with stimulation control parameters that areavailable to be selected for delivery through the communicationinterface 166 to the IPG 102 for electrical stimulation therapy or tothe secondary display unit 152 for display to a plurality of individualsin the surgical area or elsewhere. Exemplary memory include a read-onlymemory (“ROM”), a random access memory (“RAM”), an electrically erasableprogrammable read-only memory (“EEPROM”), a flash memory, a hard disk,or another suitable magnetic, optical, physical, or electronic memorydevice. The processor 160 executes software that is capable of beingstored in the RAM (e.g., during execution), the ROM (e.g., on agenerally permanent basis), or another non-transitory computer readablemedium such as another memory or a disc. The CP 104 also includesinput/output (“I/O”) systems that include routines for transferringinformation between components within the processor 160 and othercomponents of the CP 104 or external to the CP 104.

Software included in the implementation of the CP 104 is stored in thememory 305 of the processor 160, RAM 310, ROM 315, or external to the CP104. The software includes, for example, firmware, one or moreapplications, program data, one or more program modules, and otherexecutable instructions. The processor 160 is configured to retrievefrom memory and execute, among other things, instructions related to thecontrol processes and methods described below for the CP 104. Forexample, the processor 160 is configured to execute instructionsretrieved from the memory 162 for establishing a protocol to control theIPG 102. Some embodiments include software modules configured to provideinstructions for accomplishing particular tasks handled by the CP 104.For example, the CP 104 includes a programming software moduleconfigured to generate a treatment or stimulation program based on inputreceived from a user of the CP 104. A secondary display software modulecontrols the signals and communication sent from the CP 104 to thesecondary display unit 152. Additional exemplary software will bedescribed in further detail below.

Since the secondary display screen 182 is larger than the primarydisplay screen 164 as described below, the secondary display softwaremodule may be configured to enhance the resolution or otherwise formator modify the display signal in a way that creates a clearer image ofthe content on the secondary display. This may ensure that a relativelyclear image is shown on a secondary screen having a larger screen sizethan that of the CP primary display screen 164, while not requiring ashigh resolution for the smaller primary display screen 164.

One memory shown in FIG. 3 is memory 310, which can be a double datarate (DDR2) synchronous dynamic random access memory (SDRAM) for storingdata relating to and captured during the operation of the CP 104. Inaddition, a secure digital (SD) multimedia card (MMC) can be coupled tothe CP for transferring data from the CP to the memory card via slot315. Of course, other types of data storage devices can be used in placeof the data storage devices shown in FIG. 3.

The peripheral interface 178 is configured, depending on the embodiment,to receive data or signals from the IPG 102, the PFT 210, and thesurgeon input device 212. Accordingly, it may include an implantcommunication interface, a PFT communication interface, and a surgeoninput device communication interface. The implant communicationinterface includes structure and components enabling the CP 104 to sendor receive information to and from the IPG 102. For example, it maycomprise a radio transceiver that enables one-way or two-waycommunication with the IPG 102. The interface 178 may include componentsfor wireless or wired communication and may be configured with any ofthe components discussed above with reference to the secondary displaycommunication interface 176. In one example, the implant communicationinterface 178 comprises a medical implant communication service (MICS)RF transceiver used to communicate with the IPG 102 to communicatedesired changes and to receive status updates from and relating to theIPG 102, such as battery status and any error information. In thisexample, the MICS RF transceiver utilizes a loop antenna for thecommunications with the IPG 102. Other antennas, such as, for example,dipole, chip antennas, or other antennas known in the art also may beused. The CP 104 may also include a programming interface used duringmanufacturing to load an operating system and program the CP 104.

The PFT communication interface and the surgeon input devicecommunication interface may include structure and components enablingthe CP to send and receive information to and from the PFT and thesurgeon input device. These interfaces may be similar to that of theimplant communication interface, or alternatively, may be otherwiseenabled. Depending on the embodiment, the PFT communication interfaceand the surgeon input device communication interface may be one or moreports for wired communication, such as universal serial bus (USB)connectivity 355, including a Type A port and a Micro-B port; a relatedport for supporting Joint Test Action Group (JTAG) or other plug-instyle port, or may be wireless using, for example, Wi-Fi portion 325 andBluetooth portion 330 that respectively include a Wi-Fi communicationinterface, a Bluetooth communication interface, an antenna switch, and arelated antenna all of which allows wireless communication following theWi-Fi Alliance standard and Bluetooth Special Interest Group standard.Of course, other wireless local area network (WLAN) standards andwireless personal area networks (WPAN) standards can be used with the CP104. Any other interface enabling communication between the CP 104 andthe PFT 120 or surgeon input device 212 may be used. In someembodiments, the interface 178 is the same as the interface 176.

The secondary display communication interface 176 includes multiplebi-directional radio communication capabilities. Specific wirelessportions included with the CP 104 are a Wi-Fi bi-direction radiocommunication portion 325, and a Bluetooth bi-direction radiocommunication portion 330. The Wi-Fi portion 325 and Bluetooth portion330 include a Wi-Fi communication interface, a Bluetooth communicationinterface, an antenna switch, and a related antenna all of which allowswireless communication following the Wi-Fi Alliance standard andBluetooth Special Interest Group standard. Of course, other wirelesslocal area network (WLAN) standards and wireless personal area networks(WPAN) standards can be used with the CP 104.

The CP 104 includes multiple communication portions for wiredcommunication. Exemplary circuitry and ports for receiving a wiredconnector include a port for supporting universal serial bus (USB)connectivity 355, including a Type A port and a Micro-B port, a portionand related port for supporting Joint Test Action Group (JTAG)connectivity 360, and a portion and related port for supportinguniversal asynchronous receiver/transmitter (UART) connectivity 365. Ofcourse, other wired communication standards and connectivity can be usedwith or in place of the types shown in FIG. 3.

The secondary display communication interface 176 includes the structureand components enabling the CP 104 to send or receive information to andfrom the secondary display unit 152. In one embodiment, the secondarydisplay communication interface 176 is integral with the CP 104 and isavailable along an edge, such as a lower edge, under a protective coverof the CP 104. In one embodiment, the secondary display communicationinterface 176 includes a HDMI port formed in a housing of the CP 104.The interface 176 may allow connection to the external secondary displayunit 152 via a micro High-Definition Multimedia Interface (HDMI) 370,which provides a compact audio/video interface for transmittinguncompressed digital data to the external display unit 152. The use ofthe HDMI connection 370 allows the CP 104 to transmit video (and audio)communication to the external display unit 152. This may be beneficialin situations where others (e.g., the surgeon) may want to view theinformation being viewed by a CP user. The surgeon typically has novisual access to the CP 104 in the operating room. The HDMI connection370 allows the surgeon to view information from the CP 104, therebyallowing greater communication between the clinician and the surgeon.For a specific example, the HDMI connection 370 can broadcast a highdefinition television signal that allows the surgeon to view the sameinformation that is shown on the LCD (discussed below) of the CP 104. Inaddition, as HDMI signals are compatible with DVI, the CP 104 can alsobe connected, with the proper cabling, to other external display devicesthat only support DVI input. In some embodiments, audio and video can beplayed independently. In other embodiments, audio and video can beplayed in a synchronized manner.

In another embodiment, the secondary display communication interface 176includes a wireless transmitter and receiver configured to wirelesslycommunicate with the secondary display communication interface 176. Inone example, it includes structure and encoding for Wi-Fi communication.In another example, it includes structure and encoding for Bluetoothcommunication. Additional wireless protocols are contemplated. In someexamples, the secondary display communication interface 176 is anetworking port on the CP that enables the CP 104 to communicate withthe secondary display unit 152 over a WAN, LAN, or other network,including the Internet.

The CP 104 includes three hard buttons: a “home” button 335 forreturning the CP to a home screen for the device, a “quick off” button340 for quickly deactivating stimulation, and a “reset” button 345 forrebooting the CP 104. The CP 104 also includes an “ON/OFF” switch 350,which is part of the power generation and management block (discussedbelow). In some embodiments, the “reset” button 345 may be eliminated,and the “ON/OFF” switch 350 can be used to remove all power when heldlong enough.

In FIG. 2, the CP 104 includes the primary display screen 168 arrangedfor viewing by the clinician operating the CP 104 and configured todisplay information relating to the programmer 104, the IPG 102, thesecondary display unit 152, the PFT 210, and/or the surgeon input device212. The input mechanism 170 permits a user to control images on thedisplay and to make selections within a limited scope, so as to controlthe relationships between different control aspects. In FIG. 3, theprimary display screen 168 and the input mechanism 170 are merged into atouch screen I/O device 375 for providing a user interface with theclinician. The touch screen display 375 can be a liquid crystal display(LCD) having a resistive, capacitive, or similar touch-screentechnology. It is envisioned that multitouch capabilities can be usedwith the touch screen display 375 depending on the type of technologyused. However, in place of a touch screen display, a computer keyboard,a standard pointing device, such as a mouse or trackball, or other inputdevices are also contemplated.

The CP 104 includes a camera 380 allowing the device to take pictures orvideo. The resulting image files can be used to document a procedure oran aspect of the procedure. For example, the camera 380 can be used totake pictures of barcodes associated with the IPG 102 or the leads 120,or documenting an aspect of the procedure, such as the positioning ofthe leads. Similarly, it is envisioned that the CP 104 can communicatewith a fluoroscope or similar device to provide further documentation ofthe procedure. Other devices can be coupled to the CP 104 to providefurther information, such as scanners or RFID detection. Similarly, theCP 104 includes an audio portion 385 having an audio codec circuit,audio power amplifier, and related speaker for providing audiocommunication to the user, such as the clinician or the surgeon.

The CP 104 further includes a power generation and management block 390.The power block 390 has a power source (e.g., a lithium-ion battery) anda power supply for providing multiple power voltages to the processor,LCD touch screen, and peripherals.

In one embodiment, the CP 104 is a handheld computing tablet with touchscreen capabilities. The tablet is a portable personal computer with atouch screen, which is typically the primary input device. However, anexternal keyboard or mouse can be attached to the CP 104. The tabletallows for mobile functionality not associated with even typical laptoppersonal computers.

In operation, the IPG 102 (which may also be an EPG) through the use ofthe implanted medical electrical leads 108, and specifically theelectrodes 110 (FIG. 1B), stimulates neurons of the spinal cord 10. TheIPG 102 selects an electrode stimulating configuration, selects astimulation waveform, regulates the amplitude of the electricalstimulation, controls the width and frequency of electrical pulses, andselects cathodic or anodic stimulation. This is accomplished by ahealthcare professional (e.g., a clinician), using the CP 104, settingthe parameters of the IPG 102. The setting of parameters of the IPGresults in a “program,” which is also referred to herein as a“protocol,” for the electrode stimulation. Programming may result inmultiple protocols that the patient can choose from. Multiple protocolsallow, for example, the patient to find a best setting for paresthesiaat a particular time of treatment.

Returning now to the block diagram in FIG. 2, the secondary display unit152 includes a relatively large display screen suitable for displayingsystem information to a surgeon or patient when used in the operatingroom, to a group of students, or to other groups. In one example, thesecondary display unit 152 is disposed within an operating surgical roomwhere it can be seen by a surgeon performing a surgery. The secondarydisplay unit 152 includes a display screen 182, a speaker 184, amicrophone 186, and a communication interface 188. It is understood thatthe speaker 184 and the microphone 186 are optional and may be omittedin some embodiments.

Because the CP 104 is a portable device and includes a relatively smallprimary display screen 168, it is not easily viewed by multiple peopleat a single time. However, the display screen 182 of the secondarydisplay unit 152 is sized larger than the display screen 168 of theprimary CP 104 and enables multiple people to simultaneously view thescreen and allows surgeons to see the IPG status or action taken by theCP. In one example, the display screen 182 is more than twice the sizeof the primary display screen 168 of the CP 104. One exemplary displayscreen 182 is sized with a diagonal measurement greater than about 22inches. Another exemplary display screen 182 is sized with a diagonalmeasurement greater than about 30 inches. Other sizes, both larger andsmaller are contemplated. The display screen, in some examples, is alarge monitor whose image is controlled entirely from the clinicianprogrammer 104. In one example it is a smart monitor configured toconvert information received from the clinician into a three-dimensionalimage and to display information in a three-dimensional manner.

The speaker 184 and microphone 186 are linked respectively with themicrophone 174 and the speaker 172 on the CP 104. As such, communicationis enabled between individuals proximate the secondary display unit 152and the individual proximate to and operating the CP 104. As indicatedabove, this may be useful when the CP 104 and the secondary display unit152 are in different locations. In one embodiment, the communication viathe microphones and the speakers on the CP 104 and the secondary displayunit 152 communicate over the same secondary display communicationinterface 176 and the CP interface 190. In other embodiments, they haveseparate communication channels, wired or wireless, for transmitting andreceiving information.

The communication interface 188 in the secondary display unit 152includes a CP interface 190 and a peripheral interface 192. The CPinterface 190 is configured, depending on the embodiment, to receivedata or signals from the secondary display communication interface 176on the CP 104. For example, the CP interface 190 may connect to thesecondary display communication interface 176 on the CP 104 via HDMIusing a Type D Micro to Type A HDMI connector. Alternatively, or inaddition to, the HDMI signals may be compatible with DVI. Thus, the CP104 can also be connected, with the proper cabling, to other externaldisplay devices that only support DVI input.

In one example, the secondary display unit is configured to display thesame information as the primary display screen 168 on the CP 104. Thismirroring of the screens 168, 182 enables a surgeon in an operating roomand the clinician who is operating the CP to see the same information,albeit in different locations.

The peripheral interface 192 is configured, depending on the embodiment,to receive data or signals from the IPG 102, the PFT 210, and thesurgeon input device 212. In one example, the peripheral interface 192comprises a MICS RF transceiver used to communicate with the IPG 102,the PFT 210, and the surgeon input device 212. As described above, theMICS RF transceiver may utilize a loop antenna for its communications,with other antennas, such as, for example, dipole, chip antennas, orothers known in the art also considered. For example, a communicationslink can be established between the IPG 102 and the secondary displayunit 152, and communications can then occur over a MICS transceiverusing a standard frequency for a medical device transmission.

The IPG 102 includes all the treatment information required for treatingthe patient condition with the electrodes 110, but also includes acommunication interface 192. In one embodiment, the communicationinterface 192 is configured to communicate with one or both of the CP104 and the secondary display unit 152 and convey information includingIPG status, treatment status, program operation, and other informationto the CP 104 and/or the secondary display unit 152. The secondarydisplay unit 152, under the control of the CP 104, may communicate withthe IPG communication interface 192 and may convey new treatmentprograms, including electrode management routines, such as activatingparticular electrodes in a particular order with a particular intensity,by varying amplitude, pulse width, and frequency. Once these treatmentprograms are received, the IPG 102 may execute or respond to thereceived information as directed by the clinician programmer 104 throughthe secondary display unit 152. In one example, the IPG 102 alsocommunicates directly with the peripheral communication interface 178 ofthe CP 104. This embodiment may work well when the IPG 102 is in theproximity of the CP 104 and able to receive information via wireless orwired transmission.

The PFT 210 is sized to be held by a patient and can be used to providefeedback during programming of the IPG 102. In one example, the PFT 210may be used to provide feedback to the CP 104 while a clinicianoperating the CP 104, under instruction from the surgeon, develops theprotocol for the IPG 102. In one example, the PFT 210 is an ergonomichandheld device having a sensor (also referred to as input), acontroller, and a communications output. The sensor can include adiscrete switch and/or a continuously variable input, such as throughthe use of a thermocouple, strain gauge, pressure sensor, piezoelectricdevice, accelerometer, displacement mechanism, or other variable sensingmechanism. It is envisioned that the use of a continuously variableinput can provide magnitude information, thereby providing improvedfeedback information from the patient.

The PFT 210 includes a communication interface 214 that communicatesinformation to the communication interface 188 on the secondary displayunit 152, which relays the information to the CP 104. For example, thecommunication interface 214 and the peripheral interface 192 mayestablish a communication link. Communications can then occur overBluetooth or other wireless formats. The CP 104 may then, ifappropriate, adjust the display imagery on one or both of the primarydisplay screen 168 and the display screen 182 of the secondary displayunit 152 to reflect the patient feedback.

The PFT 210 is used to help the surgeon program the IPG 102 based onpatient feedback. For example in use, the CP 104 activates one or moreof the electrodes (on leads that are connected to the IPG 102) invarious patterns. When the patient feels a sensation as a result of astimulus, such as a stimulus for paresthesia, he or she activates asensor on the PFT 210. The activation of the sensor indicates to theclinician programming system 150 that the patient felt the stimulus andcan also convey the degree of sensation that is felt, depending on thetype of sensor that is employed. Given that there may be a delay fromthe time the patient feels a sensation and activates the sensor, thesystem 150 then re-stimulates the most recently-activated combinationsof electrodes, and the patient again uses the PFT 210 to indicate when(and to what degree) a sensation is felt in order to determine thecombination of electrodes to which the patient was reacting. Furtherdescription of methods for use of the PFT 210 is disclosed in U.S.patent application Ser. No. 13/118,781, filed on May 31, 2011, titled“Device to Provide Feedback For Neurostimulation Programming”, thecontents of which are incorporated herein by reference in its entirety.

In some embodiments, the patient may use the clinician programmer oranother portable device (for example an electronic tablet or anelectronic programmer) to draw a pain map and/or a stimulation map. Forexample, referring to FIG. 4, an exemplary user interface 215illustrating the generation of a pain map or a stimulation map 220 isillustrated. The user interface 215 may be displayed through atouch-sensitive screen. The user interface 215 shows a three-dimensionalmodel of a human body, which can be rotated and moved around. Using hisfingers, the patient may be able to paint the pain/stimulation map 220on a region of the human body to indicate the sensation he isexperiencing in that region. During the painting process, the patientmay choose the hue and the intensity of the color of the painted painand stimulation regions to represent the various types ofpain/stimulation or degrees of pain/stimulation. It is understood thatthe pain/stimulation map 220 may also be generated by a healthcareprofessional. The PFT 210 may be used to indicate the intensity ofpain/stimulation, but the maps are displayed either on the clinicianprogrammer (or tablet) or the external monitor.

Referring back to FIG. 2, the surgeon input device 212 is sized andconfigured to be held by the surgeon or other medical care providerwithin the sterile field in an operating room. Using it, the surgeon cancontrol one or both of the CP 104 and the secondary display unit 152.The surgeon input device 212 may permit a surgeon to select particularimages on the display screen 182 of the secondary display unit 152,which may be conveyed to the CP 104. In one embodiment, the CP allows asurgeon to select a particular electrode from an array of electrodes andto select activation including increasing and decreasing amplitude andfrequency. This communication to the CP 104 through the secondarydisplay unit 152 may help reduce the reliance on verbal cues andinstructions passed to the clinician outside the sterile field, allowingthe clinician to rely on more visual instructions simultaneouslyviewable by both the surgeon and the programming clinician. The surgeoninput device 212 includes a communication interface 216 thatcommunicates information to the communication interface 188 on thesecondary display unit 152, which relays the information to the CP 104.For example, the communication interface 216 and the peripheralinterface 192 may establish a communication link, and communications canthen occur over a MICS transceiver using a standard frequency for amedical device transmission. The CP 104 may then, if appropriate, adjustthe display imagery on one or both of the primary display screen 168 andthe display screen 182 of the secondary display unit 152 to reflect thesurgeon input.

In one aspect, this disclosure is directed to a method for displayinginformation on a CP to operating room staff working within a sterilefield. One example of this will be described with reference to FIG. 5.The CP 104 is not a sterile device, so the external connection of thesecondary display communication interface 176 may be used to displaycontent shown on the primary display screen 168 of the CP 104 to thosein the operating room while the CP 104 remains outside of the sterilefield and outside the operating room. Making the content of the primarydisplay screen 168 of the CP 104 viewable by the physician performing aprocedure reduces the interaction required between a physician and theindividual outside of the sterile field assisting the physician byperforming the programming on the CP 104. The physician can easily seethe operating state of the IPG 102 as shown on the CP 104 and does notrequire the individual assisting outside of the sterile field todescribe it. Allowing the physician himself to see the actualinformation on the primary display screen 168 of the CP 104 reduces thetime spent to perform the procedure, as well as reduce the occurrence ofany miscommunications and any resulting undesirable consequences, forexample reducing the probability of an infection.

FIG. 5 shows an operating room 250 and a clinician room 252. These areseparated by a physical barrier, shown here as a wall structure 254. Theoperating room 250 is or includes a sterile field. In the example, showna surgeon performs a procedure on a patient having an implanted IPG 102,and a clinician stands in the clinician room 252 operating the CP 104.The patient holds the PFT 210, and the surgeon holds the surgeon inputdevice 212. In this example, the CP 104 is disposed in the clinicianroom 252, and the secondary display unit 152 and the IPG 102 aredisposed in the surgical room 250. In this embodiment, the CP 104 is atablet controller fitted with a suitable communications port, forexample a micro-HDMI connector. The CP 104 is able to drive a signalover the secondary display communication interface 176 of the CP 104 andcopy the display from the primary display screen 168 on the CP 104 tothe external secondary display screen 182 on the secondary display unit152.

The secondary display unit 152 is, in this example, hung on a wall ofthe surgical room in a fixed location visible to the surgeon and hisoperating staff. In other examples, it may be visible to the surgeon andhis operating staff through a window or other barrier. As can be seen,the secondary display unit 152 is much larger than the CP 104 and isconfigured to be easily viewable by several people at the same time. Inone example, the secondary display screen 182 is at least double thesize of the primary display screen 168 of the CP 104. The secondarydisplay unit 152 includes the speaker 184, the microphone 186, and thecommunication interface 188. Verbal instructions from the surgeon to theclinician are captured at the microphone 186 and emitted from thespeaker 172 on the CP 104. Likewise, verbal responses from theprogrammer can be captured by the microphone 174 on the CP 104 and heardthough the speaker 184. In some embodiments, the contents of the screenof the CP 104 may also be broadcast via a suitable communicationsnetwork.

In the example shown, the secondary display unit 152 is hung via afixation structure 258. Here, the fixation structure 258 is a fixationbracket that extends from a rigid structure, such as the wall, andsupports the secondary display unit 152 in a fixed position. As can beseen, the secondary display unit 152 is tipped at an angle to promotesimple and convenient viewing from the sterile field in the surgicalroom. In this example it is spaced from the surgical area, and may notbe a sterile device itself. It is operated without tactile feedback orinput directly on the secondary display unit 152, and may be considereda hands-free device. It is controlled via the CP 104, but also may relayinformation collected from the IPG 102, the PFT 210, and the surgeoninput device 212. Information is also relayed back from the secondaryinput to the CP display.

The communication interface 188 on the secondary display unit 152, andparticularly the peripheral interface 192 communicates with one or moreof the IPG 102, the PFT 210, and the surgeon input device 212. Asindicated above, in one embodiment, the peripheral interface 192provides two-way communication to each of these devices. In otherexamples, the peripheral interface 192 receives one-way communicationfrom one or more of these devices. The communication interface 188 maybe attached onto or otherwise carried on the display screen 182 or on orwithin its housing.

In the illustrated embodiment, a cable 200 extends from the secondarydisplay communication interface 176 of the CP 104 to an outlet 256 shownon the wall structure 254. In this example, the secondary displaycommunication interface 176 of the CP 104 is a micro-HDMI connector, andthe cable 200 may be an HDMI cable extending between the secondarydisplay communication interface 176 of the CP 104 and outlet 256.

The outlet 254 connects to an outlet 256 in the surgical room 250 via acable within the wall, from which a cable extends to the secondarydisplay unit 152. Over this wired line, the CP 104 communicates displayinformation for presentation on the secondary display unit 152. That is,the CP 104 is able to drive a HDMI signal over the secondary displaycommunication interface 176 of the CP 104 to copy the content from theprimary display screen 168 on the CP 104 to the external display screen182 on the secondary display unit 152. This can also be done viawireless communication. In other words, the wire 200 may not be neededin some embodiments, as the communication between the secondary displayunit 152 and external devices are done wirelessly. In that case, thesecondary display unit 152 may only need a power source or a battery.

In one example, the displayed content mirrors the information displayedon the CP 104. Accordingly, by viewing the secondary display unit 152,the surgeon sees the same information as the clinician operating the CP104. In another example, the displayed content is different than orincludes additional information than that displayed on the CP 104.Accordingly, with this extended display feature, the surgeon, by viewingthe secondary display unit 152, sees different, but relevant informationthan the clinician operating the CP 104. In one example, the informationshown on the CP 104 and/or the secondary display unit 152 includes IPGstatus information, charge information, program information, status andsettings for one or more electrodes, including frequency, pulse width,and amplitude information for one or more electrodes. It may alsoinclude additional information. In one visualization of the patient'sorgans, x-ray information, or status of the patient's overall conditionincluding items such as vital signs, including blood pressure,temperature, respiratory rates, heart beat, and/or other vitals.

In one example, the secondary display unit 152 is connected to a DigitalVideo Interface (DVI) connector on the CP 104 and the content of theprimary display screen 168 was cloned, copied, or replicated onto thedisplay screen 182 of the secondary display unit 152 via the DVIinterface. In one example, the system 150 achieves 30 frames per second(FPS) when outputting the primary display screen content to an 800×600display screen 182. This is representative of the CP 104 because thedata stream format output by the CP 104 over the HDMI interface may benearly identical to that output from the DVI interface on the EVK.

In one example, the CP 104 requires the user to enable the secondarydisplay screen 182 by selecting a display mode for the external displaymonitor 152. In one embodiment, the hardware for the secondary displaycommunication interface 176 is arranged to detect when the externalsecondary display unit 152 is plugged in or otherwise connected. Usingthis functionality, the CP 104 may detect when the secondary displayunit 152 is connected to the secondary display communication interface176 of the CP 104, the driver in the CP 104 automatically switches toextending the display on the external monitor. Likewise, when theexternal secondary display unit 152 is detached, the CP 104 may disablethe mirroring or extended display function.

Software modules on CP 104 provide instructions for accomplishingparticular tasks handled by the CP 104. In the embodiment describedabove, the software includes a secondary display unit control modulethat controls the image generated on the secondary display screen 182.In one example, the module enables a user to select between twooperating modes. For example, a first mode or mirroring mode may controlthe secondary display screen 182 to show content mimicking that shown onthe primary display screen 164. In this mode, the CP 104 may generatedisplay signals for transmission to the secondary display unit 152 sothat the primary and secondary display screens show the same content. Asecond mode or extended display mode of the secondary display unit maycontrol the secondary display screen 182 to show content different thanthat shown on the primary display screen 164. In this mode, the CP 104may generate display signals for transmission to the secondary displayunit 152 so that the primary and secondary display screens showdifferent content, although some content may still overlap.

The ability to output the primary display screen display to an external,and notably, larger, secondary display unit 152, such as a large screenmonitor or projector, provides a decided advantage when it comes tocommunicating instructions to and receiving verbal responses from aclinician outside the sterile field, such as in another room. Theexternal secondary display unit 152 makes it much easier for the surgeonand others to view what is happening.

FIG. 6 shows another implementation of the system 150 according to oneexemplary aspect of the present disclosure. In this example, the CP 104and the secondary display unit 152 are illustrated being used to displayan image to a number of individuals. The system illustrated may be usedduring instructional sessions, such as during training or education, forexample.

In this embodiment, the CP 104 is a tablet controller fitted with amicro-HDMI connector, and the cable 200 is a HDMI cable extendingbetween the secondary display communication interface 176 of the CP 104and the communication interface 188 of the secondary display unit 152.The CP 104 is able to drive a HDMI signal over the secondary displaycommunication interface 176 of the CP 104 and copies the display fromthe primary display screen 168 on the CP 104 to the external displayscreen 182 on the secondary display unit 152.

In this example, the display surfaces of the primary display screen 168on the CP 104 and the external display screen 182 on the secondarydisplay unit 152 are connected with DirectDraw. Using the DirectDrawAPI, a screen copy is made of the primary display screen 168 on the CP104. A copy of the primarily display screen 168 is then drawn to thesecondary display screen's surface. In one example, the contentsdisplayed on the secondary display screen 182 mirrors that of theprimary displace seen 168. The software routine adds the ability for thescreen to be copied automatically at a user defined rate and for thecopying to be enabled or disabled as necessary.

As discussed above, the CP 104 may require the user to enable thesecondary display screen 182 by selecting a display mode for theexternal display monitor 152, may be arranged to detect when theexternal secondary display unit 152 is plugged in or otherwiseconnected. The ability to output the primary display screen display toan external, and notably, larger, secondary display unit 152, such as alarge screen monitor or projector, provides a decided advantage when itcomes to training personnel because it is much easier for multiplepeople to view what is happening.

In one embodiment, the surgeon input device 212 is not a handhelddevice, but is a motion detector associated with the secondary displayunit 152. In this embodiment, the secondary display unit 152 may includea light source and a camera or sensor to generate a depth map or otherimagery of the surgeon or other health care provider in the operatingroom 250. By detecting surgeon movement, the surgeon input device 212may receive inputs for controlling either the CP or features of thesecondary input monitor 152. For example, a surgeon may be able toselect a particular electrode or an array of electrodes using the motiondetector and increase or decrease the amplitude and frequency of pulsesfrom the electrode or electrode array to create a treatment program thatmay be loaded onto the IPG 102.

According to various aspects of the present disclosure, one or morecursors are displayed simultaneously both on the screen of the CP 104and the secondary display screen 182 of the secondary display unit 152.For the sake of illustration, a cursor 400 is illustrated on both thescreen of the CP 104 as well as on the secondary display screen 182. Thecursor 400 corresponds to an area of the screen of the CP 104 engaged bythe user (for example either through a finger or a stylus-like device).In some embodiments, the user engagement may be an actual touching ofthe area of the screen. In other embodiments, the user engagement may bea detected proximity to the area of the screen. The cursor 400 shown onthe secondary display screen 182 tracks or mirrors the cursor 400 shownon the screen of the CP 104. Thus, as the user moves his finger orstylus to interactively engage with the screen of the CP 104, theaudience can “see” exactly what the user is doing by looking at thesecondary display unit 152 through the movement of the cursor 400 on thesecondary display screen 182. It is understood that although one cursor400 is illustrated herein (one on each display screen), a plurality ofcursors may be displayed to correspond with multi-touch related userinteractions in other embodiments. The cursor 400 will be discussed inmore detail below with reference to FIGS. 8A-8B.

FIG. 7 shows one method of activating the display functionality on theCP 104. The method includes querying whether the cable is connected forthe CP to an external monitor, such as the secondary display unit 152,as indicated at step 502. If it is, then the CP 104 operates usingcontrol functionality that mirrors or extends the primary display screen168 of the CP 104 onto the connected display screen 182 of the externaldisplay monitor 152, as indicated at a step 504. The cursor at touchpoints on the primary display screen 168 of the CP 104 would also bedisplayed on the display screen 182 of the external display monitor 152.At a step 506, the CP may be used to program the IPG 102 in the mannerknown in the art. Meanwhile the secondary display unit 152 continues tomirror or extend the display serene. This continues until the systemdetermines at step 502 that the cable 200 is not connecting the CP 104and the secondary display unit 152. If not connected, the CP is operatesto end mirroring or extending CP display onto the secondary display unit152. So long as the CP 104 is connected, the functionality of thesecondary display unit 152 may be utilized. For example, in embodimentsusing the PFT 210 and/or the surgeon input device 212, the CP 104 isconfigured so that all functionality is enabled when the CP 104 and thesecondary display unit 152 are connected.

In use, a clinician may take the cable 200 and plug it into thesecondary display communication interface 176 of the CP 104. With thisconnection made the CP 104 can send display information to the secondarydisplay unit 152 for display on the display screen 182. In oneembodiment, over the same cable 200, feedback information from thesecondary display unit 152 can be transmitted to the CP 104. Thisfeedback information may be from the secondary display unit 152, orrelayed through the secondary display unit 152 to the CP 104 from thePFT 210, the IPG 102, or the surgeon input device 212. In addition, theaudio feed between the speakers and microphones on the CP 104 and thesecondary display unit 152 may also be carried over the cable 200. Inother embodiments, the system 150 includes a separate feedback lineand/or a separate audio feed line. In yet another embodiment, thecommunication occurs wirelessly over a direct connection, between the CP104 and the secondary display unit 152, such as, for example, throughinfra-red transmission, or over an indirect connection, such as througha wireless network.

The IPG 102 may then be implanted using methods and techniques known inthe art. The surgeon may give instructions to the programmer of the CP104 to activate or deactivate particular electrodes to develop atreatment program that provides a suitable level of relief to thepatient. Since the surgeon can see the secondary display unit 152, heknows whether his instructions are being properly carried out withoutadditional questions or explanation from the programmer of the CP 104.This reduction in reliance on verbal instructions may increaseefficiently of the surgical procedure. Further, during the procedure,the surgeon may intervene or request additional views of displayedinformation using the surgeon input device 212. This allows the surgeonto have a level of control over the CP 104, although that level ofcontrol may be a lesser level than the level of control of theprogrammer of the CP 104. In one example, the surgeon input device mayallow the surgeon to select an electrode and modify its frequency oramplitude of applied stimulation. Although the patient programmer is notsterile, the surgeon input device may be a sterile device, and in oneembodiment, is a single-use device that is discarded after use.

During the programming process, information from the PFT 210 may betransmitted to the secondary display unit 152. The secondary displayunit 152 may then relay the received information to the CP 104 forconsideration or processing. Based on the patient feedback, the CP 104may be controlled to update the images on the screens 164, 182 orprovide additional information for programming the implant. Software onthe CP 104 may control the images shown on the secondary display screen182, as described above.

When a stimulation program is set, it may be transmitted to the IPG 102either directly from the CP 104 or it may be transmitted to thesecondary display unit for relay to the IPG 102. The IPG may then storethe treatment program for operation.

Based on the discussions above, it can be seen that the clinicianprogrammer and devices of its type are commonly used in a setting wherea group of people is observing the actions of the user. Typically, theuser (e.g., a clinician operating the clinician programmer 104 in FIGS.5 and 6) is performing data entry or programming actions by using thetouch screen provided by the clinician programmer. Because of the sizeof the clinician programmer, it may be difficult for the user and otherobservers to precisely identify the area of the screen on the clinicianprogrammer where the user is performing the actions.

In these types of scenarios, users and observers don't know what part ofthe clinician programmer screen is being touched while the user isinteracting with the user interface. Also, in situations where theclinician programmer is connected to an external monitor, such as thesituation shown in FIGS. 5 and 6, observers don't know where the user istouching on the touch screen. In these situations, it is desirable tographically indicate the location and pressure status of the user'sfinger or stylus on the touch screen of the clinician programmer, asthat will provide additional feedback to the user and observers, therebyreducing errors such as input errors or other errors caused bymiscommunication.

According to the various aspects of the present disclosure, one or moresimulated cursors that are overlaid on top of user interface elements onthe touch screen of the clinician programmer for indication of userinterface interaction.

Referring now to FIG. 8A, an example screen 600 of a clinicianprogrammer (e.g., the screen of the clinician programmer 104 of FIGS.5-6) is illustrated. The screen shows simulated cursors 610-611. In someembodiments, these simulated cursors 610-611 are displayed when theuser's finger(s) or a stylus come into physical contact with the screen600 of the clinician programmer. The physical contact between the user'sfinger(s) and the stylus and the screen 600 may be detected via touchscreen sensors implemented on the clinician programmer. In otherembodiments, these simulated cursors 610-611 are displayed when theuser's finger(s) or a stylus do not come into physical contact with, butbecome very close to, the screen 600 of the clinician programmer. Thephysical proximity between the user's finger(s) and the stylus and thescreen 600 may be detected via proximity sensors implemented on theclinician programmer.

The location of the simulated cursors 610-611 on the screen 600corresponds to the location of the user's fingers or stylus. In theillustrated embodiment, more than one finger is detected, and thereforetwo simulated cursors 610-611 are displayed. Other numbers of fingersand/or styluses will result in their corresponding number of simulatedcursors as well. In this manner, the clinician programmer of the presentdisclosure supports multi-touch functionalities. Multi-touch may referto a touch sensitive interface's (e.g., the screen 600 of the clinicianprogrammer) capability of detecting the presence of multiple points ofcontact with the interface. For example, the touch sensitive interfacemay be able to translate the detection of the engagement (or movement)of one finger with the interface as one command, but may translate theengagement (or movement) of two or three fingers with the interface as adifferent type of command. Styluses or other objects may also be usedinstead of, or in conjunction with, fingers in other embodiments.

The construction of the simulated cursors 610-611 is such that most ofthe area they cover is transparent to show other user interface elementsthat exist in the same area. For example, the simulated cursor 610 isdisposed over a dialog box 612, but the content of the dialog box 612 isnot substantially obstructed by the display of the simulated cursor 610.If the content of the dialog box 612 contained text, for example, theuser may still be able to read such text even though portions of thetext may be overlapping with the simulated cursor 610. Upon a detectionthat the user has disengaged the screen 600, for example by releasingthe fingers or styluses, the user interface of the clinician programmerwill go back to the default mode where no simulated cursors are beingshown.

As discussed above, the clinician programmer can be electrically coupledto an external monitor such as the secondary display unit 152 of FIGS.5-6, which may be remotely located from the clinician programmer. Theexternal monitor can mirror the display of the clinician programmer'scontents. According to the present disclosure, the simulated cursors610-611 are also graphically displayed on the external monitor. Thedisplay of the simulated cursors 610-611 on the external monitor allowsthe observers to visualize what the user is doing with the clinicianprogrammer.

In more detail, sometimes it may be physically impossible for theobservers to see what part of the clinician programmer screen the useris touching. For example, the clinician programmer may be locatedoutside the view of the observers, such as in the situation illustratedin FIG. 5, where the observer (e.g., a surgeon) is located in the samesterile room 250 as the secondary display unit 152 (i.e., remoteexternal monitor), and the clinician programmer 104 and its user arelocated in a separate non-sterile room 252. In that scenario, eventhough the secondary display unit 152 can mirror the graphical displayof the clinician programmer 104, the surgeon cannot see what parts ofthe clinician programmer are being engaged by the user's fingers orstylus.

Even if the observers are in the same room as the user and the clinicianprogrammer, it is difficult for a group of observers to all get withinclose proximity to the user and see how the user is using the clinicianprogrammer (e.g., entering programming parameters). First, it may not befeasible for a group of observers to be all crowded near the user, sincespace around the user may be constricted, and the crowding around theuser may interfere with the user programming. Second, even if theobservers all manage to get within viewing distance of the clinicianprogrammer, the relatively small size of the clinician programmer meansthat the observers may not see (at least not clearly) exactly where onthe clinician programmer screen the user is touching.

According to the present disclosure, the simulated cursors 610-611 shownin FIG. 8A provide a visual indication as to where the user's finger orstylus is. Even if the observers are located in a separate room from theclinician programmer, they can still see the display and movements ofthe simulated cursors 610-611 on the external monitor. Since thesimulated cursors 610-611 track the position and movements of theclinician programmer user's fingers or styluses, the observers will knowwhat parts of the clinician programmer are being engaged by the user andwill understand the user's actions more clearly. Consequently, potentialmiscommunication between the user and the observers is reduced.

In addition to showing the position of the user's fingers or styluses onthe screen 600 or external monitor, the simulated cursors 610-611 canalso portray the action of selecting or tapping on the touch screen 600by changing the color of one or more of the simulated cursors 610-611 orhighlighting one or more of the simulated cursors 610-611 for a limitedamount of time. For example, as shown in FIG. 8B, three fingers (orstyluses or other objects) are detected in proximity of the screen 600or touching the screen. Only one finger invoked an action, for exampleby actually touching the touch screen 600, while the other two fingersare merely in proximity with but not touching the touch screen 600. As aresult, a simulated cursor 613 associated with the finger that invokedthe action is highlighted temporarily while the remaining two simulatedcursors 614-615 (associated with the fingers in proximity of the touchscreen 600) remain in their original state. In other words, thesimulated cursor 613 is triggered by activating a touch sensor on theclinician programmer, while the simulated cursors 614-615 are triggeredby activating proximity sensors on the clinician programmer.

In the embodiment illustrated, the simulated cursor 613 is highlightedwith an orange color, while the other two simulated cursors 614-615 arenot colored (or assume the same color as the color of the background inthe touch screen 600). Of course, the simulated cursor 613 may bevisually differentiated from the simulated cursors 614-615 via otherapproaches or techniques in other embodiments. For example, instead ofrepresenting the simulated cursors 613 and 614-615 with differentcolors, they may be visually differentiated with different sizes orshapes, or different associated texts, or by different animations (forexample the simulated cursor 613 may be flashing/flickering while theother simulated cursors 614-615 remain static) in various alternativeembodiments. In any case, the visual differentiation among the simulatedcursors allows the user or observers to distinguish between simulatedindicators that are tracking the detected fingers from the one fingerthat invoked an action on the CP.

FIG. 9 is a simplified block diagram of a medical device system 620 isillustrated to provide an example context of the various aspects of thepresent disclosure. The medical system 620 includes an implantablemedical device 630, an external charger 640, a patient programmer 560,and a clinician programmer 660. The implantable medical device 630 canbe implanted in a patient's body tissue. In the illustrated embodiment,the implantable medical device 630 includes an implanted pulse generator(IPG) 670 that is coupled to one end of an implanted lead 675. The otherend of the implanted lead 675 includes multiple electrode surfaces 680through which electrical current is applied to a desired part of a bodytissue of a patient. The implanted lead 675 incorporates electricalconductors to provide a path for that current to travel to the bodytissue from the IPG 670. Although only one implanted lead 675 is shownin FIG. 9, it is understood that a plurality of implanted leads may beattached to the IPG 670.

Although an IPG is used here as an example, it is understood that thevarious aspects of the present disclosure apply to an external pulsegenerator (EPG) as well. An EPG is intended to be worn externally to thepatient's body. The EPG connects to one end (referred to as a connectionend) of one or more percutaneous, or skin-penetrating, leads. The otherend (referred to as a stimulating end) of the percutaneous lead isimplanted within the body and incorporates multiple electrode surfacesanalogous in function and use to those of an implanted lead.

The external charger 640 of the medical device system 620 provideselectrical power to the IPG 670. The electrical power may be deliveredthrough a charging coil 690. In some embodiments, the charging coil canalso be an internal component of the external charger 640. The IPG 670may also incorporate power-storage components such as a battery orcapacitor so that it may be powered independently of the externalcharger 640 for a period of time, for example from a day to a month,depending on the power requirements of the therapeutic electricalstimulation delivered by the IPG.

The patient programmer 650 and the clinician programmer 660 may beportable handheld devices that can be used to configure the IPG 670 sothat the IPG 670 can operate in a certain way. The patient programmer650 is used by the patient in whom the IPG 670 is implanted. The patientmay adjust the parameters of the stimulation, such as by selecting aprogram, changing its amplitude, frequency, and other parameters, and byturning stimulation on and off. The clinician programmer 660 is used bya medical personnel to configure the other system components and toadjust stimulation parameters that the patient is not permitted tocontrol, such as by setting up stimulation programs among which thepatient may choose, selecting the active set of electrode surfaces in agiven program, and by setting upper and lower limits for the patient'sadjustments of amplitude, frequency, and other parameters.

In the embodiments discussed below, the clinician programmer 660 is usedas an example of the electronic programmer. However, it is understoodthat the electronic programmer may also be the patient programmer 650 orother touch screen programming devices (such as smart-phones or tabletcomputers) in other embodiments.

FIG. 10 shows a block diagram of one embodiment of an implantablemedical device. In the embodiment shown in FIG. 10, the implantablemedical device includes an implantable pulse generator (IPG). The IPGincludes a printed circuit board (“PCB”) that is populated with aplurality of electrical and electronic components that provide power,operational control, and protection to the IPG. With reference to FIG.10, the IPG includes a communication portion 700 having a transceiver705, a matching network 710, and antenna 712. The communication portion700 receives power from a power ASIC (discussed below), and communicatesinformation to/from the microcontroller 715 and a device (e.g., the CP)external to the IPG. For example, the IPG can provide bi-direction radiocommunication capabilities, including Medical Implant CommunicationService (MICS) bi-direction radio communication following the MICSspecification.

The IPG provides stimuli to electrodes of an implanted medicalelectrical lead (not illustrated herein). As shown in FIG. 10, Nelectrodes are connected to the IPG. In addition, the enclosure orhousing 720 of the IPG can act as an electrode. The stimuli are providedby a stimulation portion 225 in response to commands from themicrocontroller 215. The stimulation portion 725 includes a stimulationapplication specific integrated circuit (ASIC) 730 and circuitryincluding blocking capacitors and an over-voltage protection circuit. Asis well known, an ASIC is an integrated circuit customized for aparticular use, rather than for general purpose use. ASICs often includeprocessors, memory blocks including ROM, RAM, EEPROM, FLASH, etc. Thestimulation ASIC 730 can include a processor, memory, and firmware forstoring preset pulses and protocols that can be selected via themicrocontroller 715. The providing of the pulses to the electrodes iscontrolled through the use of a waveform generator and amplitudemultiplier of the stimulation ASIC 730, and the blocking capacitors andovervoltage protection circuitry 735 of the stimulation portion 725, asis known in the art. The stimulation portion 725 of the IPG receivespower from the power ASIC (discussed below). The stimulation ASIC 730also provides signals to the microcontroller 715. More specifically, thestimulation ASIC 730 can provide impedance values for the channelsassociated with the electrodes, and also communicate calibrationinformation with the microcontroller 715 during calibration of the IPG.

The IPG also includes a power supply portion 740. The power supplyportion includes a rechargeable battery 745, fuse 750, power ASIC 755,recharge coil 760, rectifier 763 and data modulation circuit 765. Therechargeable battery 745 provides a power source for the power supplyportion 740. The recharge coil 760 receives a wireless signal from thePPC. The wireless signal includes an energy that is converted andconditioned to a power signal by the rectifier 763. The power signal isprovided to the rechargeable battery 745 via the power ASIC 755. Thepower ASIC 755 manages the power for the IPG. The power ASIC 755provides one or more voltages to the other electrical and electroniccircuits of the IPG. The data modulation circuit 765 controls thecharging process.

The IPG also includes a magnetic sensor 780. The magnetic sensor 780provides a “hard” switch upon sensing a magnet for a defined period. Thesignal from the magnetic sensor 780 can provide an override for the IPGif a fault is occurring with the IPG and is not responding to othercontrollers.

The IPG is shown in FIG. 10 as having a microcontroller 715. Generallyspeaking, the microcontroller 715 is a controller for controlling theIPG. The microcontroller 715 includes a suitable programmable portion785 (e.g., a microprocessor or a digital signal processor), a memory790, and a bus or other communication lines. An exemplarymicrocontroller capable of being used with the IPG is a model MSP430ultra-low power, mixed signal processor by Texas Instruments. Morespecifically, the MSP430 mixed signal processor has internal RAM andflash memories, an internal clock, and peripheral interfacecapabilities. Further information regarding the MSP 430 mixed signalprocessor can be found in, for example, the “MSP430G2x32, MSP430G2x02MIXED SIGNAL MICROCONTROLLER” data sheet; dated December 2010, publishedby Texas Instruments at www.ti.com; the content of the data sheet beingincorporated herein by reference.

The IPG includes memory, which can be internal to the control device(such as memory 790), external to the control device (such as serialmemory 795), or a combination of both. Exemplary memory include aread-only memory (“ROM”), a random access memory (“RAM”), anelectrically erasable programmable read-only memory (“EEPROM”), a flashmemory, a hard disk, or another suitable magnetic, optical, physical, orelectronic memory device. The programmable portion 785 executes softwarethat is capable of being stored in the RAM (e.g., during execution), theROM (e.g., on a generally permanent basis), or another non-transitorycomputer readable medium such as another memory or a disc.

Software included in the implementation of the IPG is stored in thememory 790. The software includes, for example, firmware, one or moreapplications, program data, one or more program modules, and otherexecutable instructions. The programmable portion 785 is configured toretrieve from memory and execute, among other things, instructionsrelated to the control processes and methods described below for theIPG. For example, the programmable portion 285 is configured to executeinstructions retrieved from the memory 790 for sweeping the electrodesin response to a signal from the CP.

Referring now to FIG. 11, a simplified block diagram of a medicalinfrastructure 800 (which may also be considered a medical system) isillustrated according to various aspects of the present disclosure. Themedical infrastructure 800 includes a plurality of medical devices 810.These medical devices 810 may each be a programmable medical device (orparts thereof) that can deliver a medical therapy to a patient. In someembodiments, the medical devices 810 may include a device of theneurostimulator system discussed above with reference to FIG. 9. Forexample, the medical devices 810 may be a pulse generator (e.g., the IPGdiscussed above with reference to FIG. 10), an implantable lead, acharger, or portions thereof. It is understood that each of the medicaldevices 810 may be a different type of medical device. In other words,the medical devices 810 need not be the same type of medical device.

The medical infrastructure 800 also includes a plurality of electronicprogrammers 820. For sake of illustration, one of these electronicprogrammers 820A is illustrated in more detail and discussed in detailbelow. Nevertheless, it is understood that each of the electronicprogrammers 820 may be implemented similar to the electronic programmer820A.

In some embodiments, the electronic programmer 820A may be a clinicianprogrammer, for example the clinician programmer discussed above withreference to FIG. 3. In other embodiments, the electronic programmer820A may be a patient programmer or another similar programmer. Infurther embodiments, it is understood that the electronic programmer maybe a tablet computer. In any case, the electronic programmer 820A isconfigured to program the stimulation parameters of the medical devices810 so that a desired medical therapy can be delivered to a patient.

The electronic programmer 820A contains a communications component 830that is configured to conduct electronic communications with externaldevices. For example, the communications device 830 may include atransceiver. The transceiver contains various electronic circuitrycomponents configured to conduct telecommunications with one or moreexternal devices. The electronic circuitry components allow thetransceiver to conduct telecommunications in one or more of the wired orwireless telecommunications protocols, including communicationsprotocols such as IEEE 802.11 (Wi-Fi), IEEE 802.15 (Bluetooth), GSM,CDMA, LTE, WIMAX, DLNA, HDMI, Medical Implant Communication Service(MICS), etc. In some embodiments, the transceiver includes antennas,filters, switches, various kinds of amplifiers such as low-noiseamplifiers or power amplifiers, digital-to-analog (DAC) converters,analog-to-digital (ADC) converters, mixers, multiplexers anddemultiplexers, oscillators, and/or phase-locked loops (PLLs). Some ofthese electronic circuitry components may be integrated into a singlediscrete device or an integrated circuit (IC) chip.

The electronic programmer 820A contains a touchscreen component 840. Thetouchscreen component 840 may display a touch-sensitive graphical userinterface that is responsive to gesture-based user interactions. Thetouch-sensitive graphical user interface may detect a touch or amovement of a user's finger(s) on the touchscreen and interpret theseuser actions accordingly to perform appropriate tasks. The graphicaluser interface may also utilize a virtual keyboard to receive userinput. In some embodiments, the touch-sensitive screen may be acapacitive touchscreen. In other embodiments, the touch-sensitive screenmay be a resistive touchscreen.

It is understood that the electronic programmer 820A may optionallyinclude additional user input/output components that work in conjunctionwith the touchscreen component 840 to carry out communications with auser. For example, these additional user input/output components mayinclude physical and/or virtual buttons (such as power and volumebuttons) on or off the touch-sensitive screen, physical and/or virtualkeyboards, mouse, track balls, speakers, microphones, light-sensors,light-emitting diodes (LEDs), communications ports (such as USB or HDMIports), joy-sticks, etc.

The electronic programmer 820A contains an imaging component 850. Theimaging component 850 is configured to capture an image of a targetdevice via a scan. For example, the imaging component 850 may be acamera in some embodiments. The camera may be integrated into theelectronic programmer 820A. The camera can be used to take a picture ofa medical device, or scan a visual code of the medical device, forexample its barcode or Quick Response (QR) code.

The electronic programmer contains a memory storage component 860. Thememory storage component 860 may include system memory, (e.g., RAM),static storage 608 (e.g., ROM), or a disk drive (e.g., magnetic oroptical), or any other suitable types of computer readable storagemedia. For example, some common types of computer readable media mayinclude floppy disk, flexible disk, hard disk, magnetic tape, any othermagnetic medium, CD-ROM, any other optical medium, RAM, PROM, EPROM,FLASH-EPROM, any other memory chip or cartridge, or any other mediumfrom which a computer is adapted to read. The computer readable mediummay include, but is not limited to, non-volatile media and volatilemedia. The computer readable medium is tangible, concrete, andnon-transitory. Logic (for example in the form of computer software codeor computer instructions) may be encoded in such computer readablemedium. In some embodiments, the memory storage component 860 (or aportion thereof) may be configured as a local database capable ofstoring electronic records of medical devices and/or their associatedpatients.

The electronic programmer contains a processor component 870. Theprocessor component 870 may include a central processing unit (CPU), agraphics processing unit (GPU) a micro-controller, a digital signalprocessor (DSP), or another suitable electronic processor capable ofhandling and executing instructions. In various embodiments, theprocessor component 870 may be implemented using various digital circuitblocks (including logic gates such as AND, OR, NAND, NOR, XOR gates,etc.) along with certain software code. In some embodiments, theprocessor component 870 may execute one or more sequences computerinstructions contained in the memory storage component 860 to performcertain tasks.

It is understood that hard-wired circuitry may be used in place of (orin combination with) software instructions to implement various aspectsof the present disclosure. Where applicable, various embodimentsprovided by the present disclosure may be implemented using hardware,software, or combinations of hardware and software. Also, whereapplicable, the various hardware components and/or software componentsset forth herein may be combined into composite components comprisingsoftware, hardware, and/or both without departing from the spirit of thepresent disclosure. Where applicable, the various hardware componentsand/or software components set forth herein may be separated intosub-components comprising software, hardware, or both without departingfrom the scope of the present disclosure. In addition, where applicable,it is contemplated that software components may be implemented ashardware components and vice-versa.

It is also understood that the electronic programmer 820A is notnecessarily limited to the components 830-870 discussed above, but itmay further include additional components that are used to carry out theprogramming tasks. These additional components are not discussed hereinfor reasons of simplicity. It is also understood that the medicalinfrastructure 800 may include a plurality of electronic programmerssimilar to the electronic programmer 820A discussed herein, but they arenot illustrated in FIG. 11 for reasons of simplicity.

The medical infrastructure 800 also includes an institutional computersystem 890. The institutional computer system 890 is coupled to theelectronic programmer 820A. In some embodiments, the institutionalcomputer system 890 is a computer system of a healthcare institution,for example a hospital. The institutional computer system 890 mayinclude one or more computer servers and/or client terminals that mayeach include the necessary computer hardware and software for conductingelectronic communications and performing programmed tasks. In variousembodiments, the institutional computer system 890 may includecommunications devices (e.g., transceivers), user input/output devices,memory storage devices, and computer processor devices that may sharesimilar properties with the various components 830-870 of the electronicprogrammer 820A discussed above. For example, the institutional computersystem 890 may include computer servers that are capable ofelectronically communicating with the electronic programmer 820A throughthe MICS protocol or another suitable networking protocol.

The medical infrastructure 800 includes a database 900. In variousembodiments, the database 900 is a remote database—that is, locatedremotely to the institutional computer system 890 and/or the electronicprogrammer 820A. The database 900 is electronically or communicatively(for example through the Internet) coupled to the institutional computersystem 890 and/or the electronic programmer. In some embodiments, thedatabase 900, the institutional computer system 890, and the electronicprogrammer 820A are parts of a cloud-based architecture. In that regard,the database 900 may include cloud-based resources such as mass storagecomputer servers with adequate memory resources to handle requests froma variety of clients. The institutional computer system 890 and theelectronic programmer 820A (or their respective users) may both beconsidered clients of the database 900. In certain embodiments, thefunctionality between the cloud-based resources and its clients may bedivided up in any appropriate manner. For example, the electronicprogrammer 820A may perform basic input/output interactions with a user,but a majority of the processing and caching may be performed by thecloud-based resources in the database 900. However, other divisions ofresponsibility are also possible in various embodiments.

According to the various aspects of the present disclosure, electronicdata may be uploaded from the electronic programmer 820A to the database900. The data in the database 900 may thereafter be downloaded by any ofthe other electronic programmers 820B-820N communicatively coupled toit, assuming the user of these programmers has the right loginpermissions.

The database 900 may also include a manufacturer's database in someembodiments. It may be configured to manage an electronic medical deviceinventory, monitor manufacturing of medical devices, control shipping ofmedical devices, and communicate with existing or potential buyers (suchas a healthcare institution). For example, communication with the buyermay include buying and usage history of medical devices and creation ofpurchase orders. A message can be automatically generated when a client(for example a hospital) is projected to run out of equipment, based onthe medical device usage trend analysis done by the database. Accordingto various aspects of the present disclosure, the database 900 is ableto provide these functionalities at least in part via communication withthe electronic programmer 820A and in response to the data sent by theelectronic programmer 820A. These functionalities of the database 900and its communications with the electronic programmer 820A will bediscussed in greater detail later.

The medical infrastructure 800 further includes a manufacturer computersystem 910. The manufacturer computer system 910 is also electronicallyor communicatively (for example through the Internet) coupled to thedatabase 900. Hence, the manufacturer computer system 910 may also beconsidered a part of the cloud architecture. The computer system 910 isa computer system of medical device manufacturer, for example amanufacturer of the medical devices 810 and/or the electronic programmer820A.

In various embodiments, the manufacturer computer system 910 may includeone or more computer servers and/or client terminals that each includesthe necessary computer hardware and software for conducting electroniccommunications and performing programmed tasks. In various embodiments,the manufacturer computer system 910 may include communications devices(e.g., transceivers), user input/output devices, memory storage devices,and computer processor devices that may share similar properties withthe various components 830-870 of the electronic programmer 820Adiscussed above. Since both the manufacturer computer system 910 and theelectronic programmer 820A are coupled to the database 900, themanufacturer computer system 910 and the electronic programmer 820A canconduct electronic communication with each other.

FIG. 12 is a flowchart 950 illustrating a method of displaying asimulated cursor according to an embodiment of the present disclosure.The method 950 includes a step 955, in which a user interface of aclinician programmer is activated. The method 950 includes a decisionstep 960 to determine whether the proximity sensors on the clinicianprogrammer have detected one or more fingers. If the answer from thestep 960 is yes, then the method 950 proceeds to step 970. If the answerfrom the step 960 is no, then the method 950 proceeds to a decision step965 to determine whether the touch screen sensors on the clinicianprogrammer have detected one or more fingers. If the answer from thestep 965 is no, the method 950 loops back to the decision step 960. Ifthe answer from the step 965 is yes, the method 950 proceeds to thedecision step 970, in which one or more simulated cursors are displayedat all locations of sensed fingers.

The method 950 proceeds to step 975, in which the simulated cursors areupdated at all locations of the sensed fingers. The method 950 thenproceeds to a decision step 980 to determine whether action is detectedon one finger. If the answer from the decision step 980 is no, then themethod 950 loops back to the step 975. If the answer from the decisionstep 980 is yes, then the method 950 proceeds to a step 985 to highlightthe simulated cursor for the finger that caused an action temporarily.The method 950 continues to a decision step 990 to determine whether thefinger has moved away from the area of the screen corresponding to thesimulated cursor. If the answer from the decision step 990 is no, thenthe method 950 loops back to the step 975. If the answer from thedecision step 990 is yes, then the method 950 proceeds to step 995 tohide simulated cursor for the finger that moved away.

It is understood that though the method 950 refers to fingers as anexample, other input devices such as styluses may also trigger thedisplay of the simulated cursors in a similar manner. It is alsounderstood that the method 950 may include additional steps that areperformed before, during, or after the steps 955-995 discussed herein,but these steps are not specifically discussed for reasons ofsimplicity. In addition, it is understood that multi-touchfunctionalities may be implemented for each of the steps 955-995 in someembodiments. Multi-touch may refer to a touch sensitive interface's(such as a touchscreen or a touchpad) capability of detecting thepresence of multiple points of contact with the interface. For example,the touch sensitive interface may be able to translate the detection ofthe engagement (or movement) of one finger with the interface as onecommand, but may translate the engagement (or movement) of two or threefingers with the interface as a different type of command.

FIG. 13 is a flowchart 1000 illustrating a method of visualizing a userinteraction with a clinician programmer according to an embodiment ofthe present disclosure. The clinician programmer is configured toprogram a pulse generator so that the pulse generator delivers anelectrical stimulation therapy to a patient.

The method 1000 includes a step 1005 of detecting a user engagement withrespect to a screen of the clinician programmer via one or more sensorsassociated with the screen of the clinician programmer. In someembodiments, the step 1005 of detecting includes detecting a physicalcontact of the screen of the clinician programmer via a touch sensor ofthe clinician programmer. In some embodiments, a physical contact from afinger or a stylus is detected. In some embodiments, the step 1005 ofdetecting includes detecting a proximity of a finger or a stylus via aproximity sensor of the clinician programmer. In some embodiments, theengagement from the user invokes an action on the clinician programmer.

The method 1000 includes a step 1010 of determining one or morelocations on the screen of the clinician programmer corresponding to theuser engagement.

The method 1000 include a step 1015 of displaying, via an externalmonitor communicatively coupled to the clinician programmer, one or morecursors that graphically represent the one or more locations on thescreen of the clinician programmer corresponding to the user engagement,respectively. In some embodiments, the step 1015 of displaying comprisesgraphically differentiating a selected one of the cursors from the restof the cursors, wherein the selected one of the cursors corresponds tothe invoked action. In some embodiments, the step 1015 of displaying isperformed in a manner such that a majority of an area covered by thecursors is transparent. In some embodiments, the external monitor ismultiple times larger in size than the clinician programmer. In someembodiments, the external monitor and the clinician programmer arelocated in separate rooms.

The method 1000 includes a step 1020 of mirroring the displaying of theone or more cursors on the screen of the clinician programmer.

It is also understood that the method 950 may include additional stepsthat are performed before, during, or after the steps 905-945 discussedherein, but these steps are not specifically discussed for reasons ofsimplicity.

Other embodiments of the invention will be apparent to those skilled inthe art from consideration of the specification and practice of theinvention disclosed herein. It is intended that the specification andexamples be considered as exemplary only, with a true scope and spiritof the invention being indicated by the following claims.

We claim:
 1. A clinician programmer, comprising: a touch-sensitivescreen configured to display visual content to a health care provider;one or more sensors configured to detect an engagement from the healthcare provider with respect to the screen; a transceiver configured toconduct telecommunications with an external monitor that is multipletimes larger than the clinician programmer; a memory storage componentconfigured to store programming instructions; and a computer processorconfigured to execute the programming instructions to perform thefollowing tasks: detecting, via the one or more sensors, the engagementfrom the health care provider with respect to the screen; determiningone or more locations on the screen corresponding to the health careprovider's engagement; and sending signals, via the transceiver, to theexternal monitor to display one or more cursors on the external monitor,the one or more cursors graphically representing the one or morelocations on the screen of the clinician programmer corresponding to thehealth care provider's engagement, respectively.
 2. The clinicianprogrammer of claim 1, wherein the tasks further comprise mirroring thedisplaying of the one or more cursors on the screen of the clinicianprogrammer.
 3. The clinician programmer of claim 1, wherein the one ormore sensors include a touch sensor, and wherein the detecting comprisesdetecting a physical contact of the screen of the clinician programmervia the touch sensor.
 4. The clinician programmer of claim 3, whereinthe detecting the physical contact comprises detecting a physicalcontact from a finger or a stylus.
 5. The clinician programmer of claim1, wherein the one or more sensors include a proximity sensor, andwherein the detecting comprises detecting a proximity of a finger or astylus via the proximity sensor.
 6. The clinician programmer of claim 1,wherein the engagement from the health care provider invokes an actionon the clinician programmer, and wherein the displaying comprisesgraphically differentiating a selected one of the cursors from the restof the cursors, wherein the selected one of the cursors corresponds tothe invoked action.
 7. The clinician programmer of claim 1, wherein thedisplaying is performed in a manner such that a majority of an areacovered by the cursors is transparent.
 8. The clinician programmer ofclaim 1, wherein the clinician programmer is configured to program apulse generator so that the pulse generator delivers an electricalstimulation therapy to a patient.
 9. A medical system, comprising: amonitor; and a clinician programmer located remotely from the monitor,the clinician programmer being configured to program parameters of anelectrical stimulation therapy for a patient, the clinician programmerincluding: a touch-sensitive screen configured to display visual contentto a health care provider; one or more sensors configured to detect anengagement from the health care provider with respect to the screen; atransceiver configured to conduct telecommunications with the monitor; amemory storage component configured to store programming instructions;and a computer processor configured to execute the programminginstructions to perform the following tasks: detecting, via the one ormore sensors, the engagement from the health care provider with respectto the screen; determining one or more locations on the screencorresponding to the health care provider's engagement; and sendingsignals, via the transceiver, to the monitor to display one or morecursors on the monitor, the one or more cursors graphically representingthe one or more locations on the screen of the clinician programmercorresponding to the health care provider's engagement, respectively.10. The medical system of claim 9, further comprising a pulse generatorprogrammable by the clinician programmer to deliver the electricalstimulation therapy to the patient.
 11. The medical system of claim 9,wherein the tasks further comprise mirroring the displaying of the oneor more cursors on the screen of the clinician programmer.
 12. Themedical system of claim 9, wherein the one or more sensors include atouch sensor, and wherein the detecting comprises detecting a physicalcontact of the screen of the clinician programmer via the touch sensor.13. The medical system of claim 12, wherein the detecting the physicalcontact comprises detecting a physical contact from a finger or astylus.
 14. The medical system of claim 9, wherein the one or moresensors include a proximity sensor, and wherein the detecting comprisesdetecting a proximity of a finger or a stylus via the proximity sensor.15. The medical system of claim 9, wherein the engagement from thehealth care provider invokes an action on the clinician programmer, andwherein the displaying comprises graphically differentiating a selectedone of the cursors from the rest of the cursors, wherein the selectedone of the cursors corresponds to the invoked action.
 16. The medicalsystem of claim 9, wherein the displaying is performed in a manner suchthat a majority of an area covered by the cursors is transparent. 17.The medical system of claim 9, wherein the monitor is multiple timeslarger in size than the clinician programmer.
 18. An apparatus forvisualizing an interaction associated with a health care provider, theapparatus comprising: means for detecting an engagement from the healthcare provider with respect to a screen of a clinician programmer, theclinician programmer being configured to program a pulse generator sothat the pulse generator delivers an electrical stimulation therapy to apatient; means for determining one or more locations on the screen ofthe clinician programmer corresponding to the engagement from the healthcare provider; and means for displaying or more cursors that graphicallyrepresent the one or more locations on the screen of the clinicianprogrammer corresponding to the engagement from the health careprovider, respectively, wherein the means for the displaying is remotelylocated from, and communicatively coupled to, the clinician programmer.19. The apparatus of claim 18, further comprising means for mirroringthe displaying of the one or more cursors on the screen of the clinicianprogrammer.
 20. The apparatus of claim 18, wherein the means fordetecting comprises a touch sensor for detecting a physical contact ofthe screen of the clinician programmer, the physical contact being madeby a finger or a stylus.
 21. The apparatus of claim 18, wherein themeans for detecting comprises a proximity sensor for detecting aproximity of a finger or a stylus.
 22. The apparatus of claim 18,wherein the engagement from the health care provider invokes an actionon the clinician programmer, and wherein the means for displayingcomprises means for graphically differentiating a selected one of thecursors from the rest of the cursors, wherein the selected one of thecursors corresponds to the invoked action.
 23. An electronic device,comprising: a touch-sensitive screen configured to display visualcontent to a health care provider; one or more sensors configured todetect an engagement from the health care provider with respect to thescreen; a radio configured to establish a communications link betweenthe electronic device and an external monitor, wherein the externalmonitor has a display that is larger than the touch-sensitive screen; amemory storage component configured to store programming instructions;and one or more computer processors configured to execute theprogramming instructions to perform the following steps: detecting anengagement from the health care provider with respect to thetouch-sensitive screen via the one or more sensors; determining one ormore locations on the touch-sensitive screen corresponding to theengagement from the health care provider; and causing the externalmonitor to display one or more cursors that graphically represent theone or more locations on the touch-sensitive screen, respectively. 24.The electronic device of claim 23, wherein the steps further comprise:displaying the one or more cursors on the touch-sensitive screen. 25.The electronic device of claim 23, wherein the one or more sensorsinclude a touch sensor, and wherein the detecting comprises detecting aphysical contact of the touch-sensitive screen via the touch sensor. 26.The electronic device of claim 25, wherein the detecting of the physicalcontact comprises detecting a physical contact from a finger or astylus.
 27. The electronic device of claim 23, wherein the one or moresensors include a proximity sensor, and wherein the detecting comprises:detecting a proximity of a finger or a stylus via the proximity sensor.28. The electronic device of claim 23, wherein the engagement from thehealth care provider invokes an action on the electronic device, andwherein the external monitor graphically differentiates a selected oneof the cursors from the rest of the cursors, wherein the selected one ofthe cursors corresponds to the invoked action.
 29. The electronic deviceof claim 23, wherein the external monitor displays the one or moresensors in a manner such that a majority of an area covered by thecursors is transparent.
 30. The electronic device of claim 23, whereinthe touch-sensitive screen is multiple times smaller in size than theexternal monitor.
 31. The electronic device of claim 23, wherein theelectronic device is physically separated from the external monitor indifferent rooms.
 32. The electronic device of claim 23, wherein theelectronic device is configured to program a pulse generator so that thepulse generator delivers an electrical stimulation therapy to a patient.